Plan creates workforce pipeline, supports research

By JULIE MINDA

An unusual collaboration formed in 2015 by three Minnesota faith-based nonprofits aims to identify and address challenges in long-term care including workforce shortages and ways to continuously improve care quality.

The initiative marries the brain power and expertise of leaders of two aging services organizations with that of the faculty and students at a university with a focus on training health care professionals. Duluth-based Benedictine Health System; Minneapolis-St. Paul-based St. Catherine University and Roseville-based Presbyterian Homes & Services are the founding partners of the initiative called CareForce Innovation.

They are devising ways to build up the direct care workforce, to use innovation and research to improve care quality and to redesign the care delivery process.

Lee Larson, president of the Benedictine Health System Foundation and senior vice president of community engagement and innovation for Benedictine Health System, said the collaboration is a rare opportunity for eldercare providers to partner with a top academic institution. Benedictine operates more than 40 eldercare communities in five states; and Presbyterian, 43 such communities in three states.

Larson

Larson said the partnership is "creating new energy, new solutions and new ways of coming at problems" and challenges in long-term care.

Now hiring
According to projections from the U.S. Census Bureau, by 2020, nearly 17 percent of the U.S. population will be 65 years and older; and by 2030 about 20 percent will be in that age group. According to information from the CareForce partners, about 70 percent of people age 65 and older will require some type of institutional, home or community-based support as they age.

Long-term care providers in Minnesota and elsewhere already struggle to hire and keep registered nurses and direct care staff. According to 2014 information from the Minnesota Employment Review, 76 percent of new nurse graduate hires working in eldercare organizations had left and taken jobs elsewhere within 18 months of their start date.

Penelope Moyers is the founding dean of the Henrietta Schmoll School of Health at St. Catherine, a Catholic university with an enrollment of more than 4,700 students — about 2,200 of whom are enrolled in health care degree programs. The School of Health offers associate, bachelor's, and graduate degrees in a wide variety of practice areas. Moyers, who is the university's top representative on the CareForce team, said a survey of St. Catherine students in health care majors revealed that aging services was on the bottom of most students' list of health care fields where they would want to work. Moyers said that this could be because students assume salaries are lower in long-term care and that there are fewer paths for career development. Also, students may be wowed by the media's portrayal of acute care facilities as exciting places to practice — long-term care sites are not portrayed the same way, she said.

Moyers

Progress
To give students preparing for health care careers real-life exposure to long-term care work, the partners created the CNA Pathways Program. Participants work in certified nursing assistant jobs at Benedictine and Presbyterian facilities in the greater Minneapolis-St. Paul area. The CNAs in the market typically earn a starting wage of between $12 to $14 per hour, said Moyers. By comparison, students who work at the university campus generally earn about $11 per hour, she said.

The Pathways program provides annual scholarships of $7,500 to eligible St. Catherine students. The program includes job readiness training, and it connects students with faculty mentors. Pathways presents workshops for its students on aging research and other topics. Pathways has been up and running for four semesters, with one class of participants per semester. This semester, 23 students are enrolled.

Moyers said early assessments indicate the Pathways program is having a positive impact on students' perceptions of eldercare work.

Jessica Tiffany has a bachelor's degree in biology and is pursuing her Master of Science in Nursing degree through a St. Catherine program that also will prepare her to sit for the national test required to be a registered nurse in the U.S. She has been working part-time as a CNA for about seven months at a Benedictine long-term care facility in the suburbs of St. Paul. She says her experience with Pathways has made her open to work in long-term care upon graduation.

Jessica Tiffany practices taking a patient's pulse on a medical mannequin in the nursing lab at St. Catherine University in Minneapolis-St. Paul. She is taking part in a program that exposes her to careers in long-term care while she pursues her education in nursing.

Tiffany said the Pathways program dispels myths students may have about nursing in long-term care. For instance, students may believe working in long-term care would be sad — because of the struggles the elders face as they age and because of the inevitability of grief when residents die. Tiffany has found that "there are also small humorous moments and joy every day."

She said she enjoys building relationships with residents and supporting them through the changes they are experiencing in their lives. It would be difficult to build such relationships in acute care settings, she said, because of the short stays common in hospitals.

The CareForce partners are exploring how they might work with other Minnesota colleges and universities to open more nursing school slots in the state. Currently many candidates are turned away because of the lack of slots.

Scholarly pursuits
In addition to workforce initiatives, the CareForce partners are focusing on care quality research. They've built on a preexisting St. Catherine clinical scholar program that engages St. Catherine faculty and students in research. The student researchers are in clinical doctorate and master's degree programs within the health care field, such as nursing physical therapy and occupational therapy. In some cases, the research serves as their core project to earn their degree. Grants from CareForce partners and other funders support the research.

In the past, research has focused solely on acute care settings. Now, in partnership with CareForce, the graduate students are digging into issues important to Benedictine and Presbyterian.

The clinical scholars have worked with staff at Benedictine facilities on a pain reduction study for rehabilitation patients and a pneumonia prevention program for ventilator patients and helped implement the learnings.

Moyers said such scholarly work is important to the field because while national guidelines have been developed on many clinical protocols, rarely are these guidelines designed for implementation in a population of frail seniors. "We redesign them and study if they address the problem" for seniors in long-term care.

Next up
While the partners have made progress in the areas of workforce development and care quality research, they have yet to initiate programming in the third area of concern, designing a better delivery process. The work in this area could include using technology to improve seniors' quality of life, and keep seniors living in their homes safely, as long as possible. The work also could include assessing creative staffing models used in other countries, to improve both care delivery for residents and working conditions for staff at long-term care facilities.

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